Low priority treatments

The NHS must demonstrate that it is making the most effective use it can of public money to deliver quality healthcare. The aim of this policy is to set out an overview of those interventions or procedures considered to be of low clinical priority, such as surgery for cosmetic reasons. There is evidence that many of these interventions or procedures are clinically effective and may bring benefit at an individual level. However, the role of the commissioners is to ensure that public funding is directed to best meet the identified health needs of the population and therefore must take a view on population level prioritisation of relevant interventions and treatments. As part of this process commissioners must therefore make a judgement on those procedures that are not considered a priority.

Implementation of the policy in Primary Care is a pre-requisite to avoid inappropriate referrals with its unintended consequences such as:

  • Raising patient expectations
  • Relying on secondary care clinicians to turn back referrals and act as gatekeepers

Low Priority Treatment Policy

Scope

This policy includes:

  • All treatments requested for cosmetic/aesthetic reasons in any specialty
  • Applies to patients of all ages
Examples of the treatments which will not be funded; this list is not exhaustive

Out of scope

  • Patients with suspected or diagnosed cancer

Referral

Referral Criteria

GP referrals should
  • Be in line with policy
  • Any referrals not in line with policy will be sent back to the GP with an explanatory letter
Exceptionality

It is recognised that every patient is an individual and that there may be particular circumstances which give grounds for funding treatment in an individual case contrary to the decision not to fund in general.

In making a case for special consideration it needs to be demonstrated that:

  • the patient is significantly different to the general population of patients with the condition in question; and
  • the patient is likely to gain significantly more health benefit from the intervention than might be normally expected for patients with that condition.
  • the fact that a treatment is likely to be efficacious for a patient is not in itself, a basis for exceptionality.
Information to be included in requests for funding
  • BMI
  • Photographs
    • Where possible the face should be excluded from the photograph. The photograph should be taking in a standing position, with the arms held naturally to the side of the body. Front and side views are required.
  • Measurements
    • Breast referrals to include breast size in relation to frame and bra size.
      • In breast asymmetry – demonstrate disparity between breasts, and distance between clavicle to nipple.
    • Waist and hip measurments
  • Other information
    • Details of pain
    • Prescribed medication
    • On-going care of any psychology/psychiatric services and up to date reports
      • Referrals to these services should no longer be made specifically in order to support the request for funding, unless it is appropriate for the patient to receive on-going care from these services.

Referral Instructions

A referral to secondary care services should not be made prior to approval for the procedure being given by the Restricted Treatments Funding Panel, unless the relevant criteria are met.

All applications should be made in writing by the relevant clinician, in most cases this will be the patients GP as they are able to demonstrate more clearly the impact of the patient's condition on their day to day life. In certain circumstances it may be relevant for another clinician to submit an application for funding approval; however, these cases are considered to be rare. The panel is unable to accept requests for funding directly from the patient.

Following the meeting of the panel, the decision will be conveyed to the requesting clinician. It is the responsibility of the requesting clinician to convey the decision of the panel to the patient in a timely manner. The patient should not be directed to the panel as it is not able to pass this information to the patient.

Should a negative decision be reached, details of the Appeals and Complaints process will also be provided.

Applications for consideration for funding approval should be sent to:

  • Email: d-ccg.ifr-newsdt@nhs.net
  • Alternatively, please send to: The Panel administrator at Bridge House, Collett Way, Newton Abbot, TQ12 4PH

Supporting Information

Patient Information

Patient information leaflet

Evidence

Low Priority Treatment Policy

Restricted treatment funding panel process

Pathway Group

The four PCTs in the South West Peninsula worked closely in developing this policy to ensure consistency of approach.

Policy published: 07 September 2011

 

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